HIV Prevention and Management
Every Blue Cross member deserves access to exceptional health care, including preventive care and essential medications, regardless of their sexual identity or orientation. Our health plans cover medications for HIV prevention, and they also cover medications that can lower HIV levels in members who are living with HIV.
Pre-exposure Prophylaxis (PrEP)
Pre-exposure prophylaxis (PrEP) is medicine that people at risk for human immunodeficiency virus (HIV) take to prevent getting HIV from sex or injection-drug use. PrEP can stop HIV from taking hold and spreading throughout your body. Currently, there are two daily oral medications for PrEP and one injectable treatment, all of the treatments are approved by the U.S. Food and Drug Administration (FDA).
Steps for getting pre-exposure prophylaxis
Consult your primary care provider (PCP) to see if PrEP is right for you. If your PCP is unsure of how to prescribe PrEP, they may refer you to another provider more equipped to prescribe it. Your PCP may refer you to an infectious disease specialist, a urologist, a gynecologist, or a specialized clinic.
PrEP can help protect you if you don’t have HIV and if any of the following apply to you:
- You have had anal or vaginal sex in the past six months, and you:
- Have a sexual partner with HIV (especially if the partner has an unknown or detectable viral load),
- Have not consistently used a condom, or
- Have been diagnosed with a sexually transmitted infection (STI) in the past six months
The FDA has approved three types of PrEP:
- Truvada® is for people at risk through sex or injection-drug use.
- Descovy® is for people at risk through sex. Descovy isn’t for people assigned female at birth who are at risk for HIV through receptive vaginal sex.
- Apretude is for people at risk through sex.
During your appointment, talk openly with your health care provider about your reasons for wanting to take PrEP. They'll assess your risk factors for HIV and discuss whether PrEP is suitable for you.
Your provider may do a medical evaluation. This includes HIV testing, kidney function tests, and tests for other sexually transmitted infections (STIs). They'll assess your overall health to ensure that PrEP is safe and appropriate for you.
Your health care provider should provide comprehensive counseling about PrEP, including:
- How it works
- Its effectiveness
- Potential side effects
- Adherence
- The need for regular follow-up appointments and testing while on PrEP
Under the Affordable Care Act, PrEP must be free under most health insurance plans. That means, in most cases, you can’t be charged for your PrEP medication or the clinic visits and lab tests that you need to maintain your prescription. Consult with your doctor to discuss which is the best option for you (oral medication or injectable).
Your provider and pharmacist will work with your insurance company to determine which PrEP medications are covered. Blue Cross Blue Shield of Massachusetts doesn’t require an authorization for PrEP. However, if you are part of an employer-based health plan that covers its own pharmacy costs, you may need an authorization. Talk to your benefits manager to understand your pharmacy coverage. If your employer doesn’t have pharmacy benefits with Blue Cross, we still cover office visits, lab tests, and many other services.
Once prescribed, take PrEP as directed by your health care provider. It's essential to take it consistently to ensure maximum effectiveness.
If you are taking the injectable version of PrEP (Apretude), after your first two monthly injections, you will need to receive injections every two months until you no longer wish to take PrEP.
Attend all scheduled follow-up appointments for HIV and STI testing, kidney function checks, and discussing any concerns or questions. Follow-ups typically occur every three months.
How much does (PrEP) typically cost?
To see how much Pre-Exposure Prophylaxis (PrEP) costs, sign in to MyBlue to use our Medication Lookup tool and view your options.
Antiretroviral Therapy (ART)
Antiretroviral therapy (ART) is a treatment for people who are living with human immunodeficiency virus (HIV) using anti-HIV drugs. The standard treatment consists of a combination of drugs (often called "highly active antiretroviral therapy" or HAART) that suppress HIV replication.
Steps for getting antiretroviral therapy
If you suspect you may have HIV or if you've engaged in activities that could put you at risk for HIV transmission, get tested as soon as possible. A health care provider will perform HIV tests to diagnose your condition.
Schedule an appointment with a healthcare provider specializing in HIV care or infectious diseases. This could be a primary care physician, an infectious disease specialist, or an HIV specialist.
During the appointment, the health care provider will conduct a thorough evaluation, including reviewing your medical history, discussing your HIV diagnosis, performing blood tests to measure your viral load and CD4 count, and assessing your overall health.
Your health care provider will discuss the benefits of starting ART, including:
- Reducing HIV-related complications
- Preventing transmission to others
- Improving your overall health
They'll also explain how ART works, the medications involved, potential side effects, and adherence requirements.
If your provider determines that ART is right for you, they’ll prescribe a specific combination of ART medications just for you. They'll provide instructions about how to take the medicines, the dosages, and any potential interactions with other medications or supplements.
Under the Affordable Care Act, ART must be free under most health insurance plans. That means, in most cases, you can’t be charged for your ART medication or the clinic visits and lab tests that you need to maintain your prescription.
Your provider and pharmacist will work with your insurance company to determine which ART medications are covered. Blue Cross doesn’t require authorization for ART. However, if you are part of an employer-based health plan that covers its own pharmacy costs, you may require authorization. Talk to your benefits manager to understand your pharmacy coverage. If your employer doesn’t have pharmacy benefits with Blue Cross, we still cover office visits, lab tests, and many other services.
Once prescribed, take ART as directed by your health care provider. It's essential to take it consistently to ensure maximum effectiveness.
Attend all scheduled follow-up appointments for HIV and STI testing, kidney function checks, and discussing any concerns or questions. Follow-ups typically occur every three months.
How much does (ART) typically cost?
To see how much Antiretroviral Therapy (ART) costs, sign in to MyBlue to use our Medication Lookup tool and view your options.
Post-Exposure Prophylaxis (PEP)
Post-exposure prophylaxis (PEP) is a medicine taken to prevent HIV after a possible exposure. PEP should be used only in emergencies and must be started within 72 hours after a possible recent exposure to HIV.
Steps for getting post-exposure prophylaxis
Talk right away (within 72 hours) to your health care provider, an emergency medicine doctor, or an urgent care provider about PEP if you think you’ve been recently exposed to HIV:
- During sex (e.g., if the condom broke)
- Through sharing needles, syringes, or other equipment to inject drugs (e.g., cookers)
- If you’ve been sexually assaulted
The sooner you start PEP, the better. Every hour counts. If prescribed PEP, you must take it daily for 28 days.
PEP is for emergencies only. The medication:
- Is given after a possible exposure to HIV.
- Isn’t a substitute for regular use of other HIV prevention.
- Isn’t the right choice for people who may be exposed to HIV frequently.
If you’re at risk for HIV from repeated exposures, talk to your health care provider about PrEP (pre-exposure prophylaxis).
Under the Affordable Care Act, PEP must be free under most health insurance plans. That means, in most cases, you can’t be charged for your PEP medication or the clinic visits and lab tests that you need to maintain your prescription.
Your provider and pharmacist will work with your insurance company to determine which PEP medications are covered. Blue Cross doesn’t require an authorization for PEP. However, if you are part of an employer-based health plan that covers its own pharmacy costs, you may require authorization. Talk to your benefits manager to understand your pharmacy coverage. If your employer doesn’t have pharmacy benefits with Blue Cross Blue Shield of Massachusetts, we still cover office visits, lab tests, and many other services.
Once prescribed, take PEP as directed by your health care provider. Taking it consistently is essential to ensure maximum effectiveness.
Attend all scheduled follow-up appointments for HIV and sexually transmitted infection (STI) testing, kidney function checks, and discussing any concerns or questions. Follow-ups typically occur after a month of taking PEP regularly to ensure you prevent HIV transmission.
How much does PEP typically cost?
To see how much PEP costs, sign in to MyBlue to use our Medication Lookup tool and to view your options.
Questions About HIV Prevention and Management Medications
Call us if you have any questions about your plan’s coverage for HIV prevention and management medications.